Plastic Surgeons NYC,Plastic Surgeons New York, New York Cosmetic Surgeon .|Informative Articles for the community of NY & The General public on Facial Plastic Surgery, Breast Augmentation and Reduction,Tummy Tucks,Blepharoplasty, Rhinoplasty, Liposuction / Liposculpture and other important New York Plastic Surgery procedures

Tuesday, January 30, 2018

Dr. Magana is devoted to the art
and science of plastic surgery. His early background in the arts and movie
industry in Hollywood furthered his deep appreciation for beauty and
aesthetics.

After completing his six years of medical school, he continued with
seven more years of rigorous training in general surgery. He then
participated in numerous fellowships, including two years of burn surgery at
New York Hospital, craniofacial surgery at Children’s Hospital in Salt Lake
City, Utah and aesthetic and reconstructive breast surgery at the Northern
Westchester Aesthetic Institute in Mount Kisco, NewYork. Continuing with his
extensive education, he went on to complete a two year residency in Plastic and
Reconstructive Surgery at the prestigious Medical College of Georgia. He
has co-authored publications, including scientific articles and book chapters
about reconstructive surgery. Upon completion of his plastic surgery
training, Dr Magana was awarded the esteemed Kenna Given Award for his
dedication to excellence.

Dr. Magana currently travels on
mission trips to southeast Asia to perform cleft lip and palate repairs, as
well as, other reconstructive surgery for underprivileged and segregated
communities.

Presently, Dr. Magana’s offices
are located on Putnam Avenue in Greenwich, Connecticut and on Park Avenue in
New York City. It is here that he implements his talent as an artist and
his expertise as a physician to obtain optimal results and create beauty in a
subtle, natural manner. He performs surgery at the state of the art
facilities at Stamford Hospital and Northern Westchester Hospital. Dr.
Magana works hard at fostering relationships between himself and his patients,
as well as his colleagues, who have often described him as being kind,
knowledgeable, and meticulous.

Thursday, July 21, 2011

Dark Circles around a panda bears eyes may be cute... but... not so much under your eyes..

Courtesy of Womans fitness.net

What causes them?

-Heredity: dark eye circles may run in families

-Allergies
-Atopic dermatitis (eczema)
-Lifestyle: stress, Alcohol abuse, lack of sleep
-Nasal congestion: this may cause engorgement of the veins around the eyes that drain the region creating a ---Bluish hue from chronic venous congestion
-Pigmentation irregularities: may be more common in people of color, especially blacks and Asians
-Rubbing or scratching the area
-Sun exposure which induces formation of melanin (substance that gives skin its color)
-Thinning skin and loss of fat and collagen: this occurs with age, making the underlying vasculature more visible

Wednesday, July 20, 2011

Several thousands of women undergo breast augmentation every year. Many of them in childbearing age. A frequent concern regarding silicone implants is whether or not the ability to breast feed is preserved, and if so, is it of any consequence to the baby. Fortunately, to date, there seems to be no major implication to the child in these circumstances. Studies analyzing the amount of silicone contained in the milk of lactating mothers when compared to commercial formulas have found little difference in the silicone content. The importance of breast feeding is undeniable. Medical literature has documented the nutritional and immune-stimulating properties of of maternal milk when compared to commercial formulas. Maternal milk seems to be particularly protective against common childhood conditions such as Eczema, Iron deficiency anemia and Otitis media. Other less common and more serious diseases seem to be unequivocally mitigated by breast feeding; upper and lower respiratory infections and lymphoma amongst others.
For these reasons, it is recommendable to breast feed if the mother is able to do so. Approximately 50% of women are able to breast feed at baseline, and it is important for the physician to discuss this prior to undergoing breast augmentation with silicone or saline implants since it is unknown whether a patient is able to breast feed at baseline prior to the procedure.

Angelina Jolie Breastfeeding Courtesy of fashionexplorer.net

A study published in PRS in 1998 undertook the arduous task of comparing the levels of silicone in breast milk from lactating women with and without silicone implants.
Two other sources were also included in the study consisting of cow's milk and infant formula for silicon content.
The samples were prepared in a special class one hundred "ultraclean" laboratory and analyzed via graphite furnace atomic absorption spectrophotometry. Silicon levels were analyzed in breast milk, whole blood, cow's milk, and 26 brands of infant formulas.

-Lactating women with implants were found to be comparable to control groups when measuring silicon levels:

(55.45 +/- 35 and 51.05 +/- 31 ng/ml, respectively)

-In blood (79.29 +/- 87 and 103.76 +/- 112 ng/ml, respectively).

-The mean silicon level measured in store-bought cow's milk was 708.94 ng/ml, and that for 26 brands of commercially available infant formula was 4402.5 ng/ml (ng/ml = parts per billion)

-lactating women with silicone implants are similar to control women with respect to levels of silicon in their breast milk and blood.

-Silicon levels are 10 times higher in cow's milk and even higher in infant formulas.

In conclusion: there is no current evidence that would suggest that silicone implants have any undesirable effect on the child in the breast feeding period.

- Do silicone implants reduce the ability to breast feed?

The breast tissue that produces milk is in reality a modified sweat gland. It lies over the pectoralis major muscle and is composed of units known as lobes. Each lobe is composed of lobules. Small ducts emanate from the lobules where the milk is produced and then channeled toward the nipple where they coalesce into several lactiferus sinus which then empty into the nipple. Silicone implants are always placed behind the gland and does not divide the ducts or damage them. If the lobules and ducts are intact, the production of milk shouldn't change. Of the four procedures to insert implants, only one may divide the breast tissue containing the ducts, namely, the Trans-areolar approach. In general, even this approach usually does not affect breast feeding.

Breast implant approaches:

-Trans-Areolar:divides breast tissue, but usually does not affect lactation-Inframammary incision:This incision is made under the breast crease and introduces the implant behind the breast tissue, avoiding the gland alltogether-Trans-axillary Incision:In this method, the incision is in the axilla and the implant is once again introduced behind the breast tissue without damaging the glandular breast tissue-TUBA Trans-umbilical Breast Augmentation:this procedure is only appropriate for saline implants and it uses a scope for dissection from the umbilicus to the retro-mammary space (behind the mammary gland) and does not affect the gland.

It has been documented that a women undergoing breast implant placement have a 2.6 to 3 times greater risk of not being able to breast feed than the rest of the population. This is in part attributable to the surgical approach which may be trans-areolar, and to the possible unwillingness of the mother to lactate after augmentation.
It should also be mentioned that if a woman is already lactating and wishes to have breast implants, it is advisable to wait for 6 months prior to undergoing augmentation. Milk accumulation has been documented in the peri-prosthetic space after surgery when augmentation is performed earlier.

Sunday, July 17, 2011

Axillary Hyperhidrosis (AH) is a condition characterized by excessive sweating in the armpit area. It is uncomfortable to patients who suffer it and can result in depression in some cases. It may exacerbated by different emotional states such as nervousness or anxiety. In the stricter sense, Hyperhidrosis is sweating in excess of the required amount normally needed for thermoregulation.
The ethiology (cause) of AH can be divided into primary and secondary. The primary has no recognizable cause for the excess activity of the Eccrine glands (Sweat Glands). Secondary Hyperhidrosis is caused by a concomitant illness or recognizable associated causes including certain medications.

Prior to treatment, a thorough history and physical exam should be done to exclude any causes of secondary hyperhidrosis.
Diagnistic tests for this condition include:

-The Starch-iodine test. In this test, an iodine solution is applied to axillary area bilaterally. Once it has dried, starch is sprinkled on the site. The combination of excessive sweat and starch results in a dark blue color yielding a positive result in the presence of hyperhidrosis. This is often patchy in nature, revealing the most concentrated sites of sweat secretion

-In the Paper test. Special paper is placed on the affected area to absorb the sweat, it is then weighed to determine the amount of sweat contained in it.

-The most accurate to determine the presence of hyperhidrosis is with a device called a VapoMeter which provides an objective measurement for the amount of sweat. It measures the relative humidity in grams per meter square per hour and is quite accurate. Three measurements are done in the clinic and a control site such as the forearm is used as a control.

What are the treatment options?Non Surgical treatments include:
-Antiperspirants: Usually in the form of aluminum chloride hexahydrate which will occlude the outlet of the gland decreasing the actual perspiration versus a deodorant which does not address the amount of sweat being perspired
-Iontophoresis: This method is FDA approved and uses a small electrical stimulus to reduce the amount of secretion in the affected area. It is most effective in the soles of the feet and the palms. The mechanism of action seems to be mild thickening of the regionally affected skin.
-Systemic Medications:Usually in the form of Anticholinergics such as Glycopyrrolate which decrease the amount of sweat being produced. These medications may have side effects such as a dry mouth, Dizzines and sometimes produce difficulties urinating.
-Botox: Type A botullinum type toxin is FDA approved for the treatment of Hyperhidrosis. It is generally effective in decreasing the symptoms associated to AH. It's mechanism of action consists in blocking the signal from the regulating nerve to the actual gland. Downsides to this treatment are that it is temporary and should be repeated every 3-6 months, may be locally painful and also produce a some local transitory weakness. It may be applied with a pre-fabricated grid shape, or with a more targeted fashion by following the the "Minor's Starch Iodine test enhanced sites which are sometimes scattered.Surgical Options:
-Endoscopic Thoracic Sympathectomy : This procedure is done via 2 incisions in the axilla. The sympathetic chain is localized next to the vertebral column anteriorly and then divided, thus cutting the nerve supply to the sweat glands. In the right hands, this procedure has a high success rate of 90-95%. There may be recurrence a small percentage of the time, or compensatory sweating in other parts of the body as a result of the sympathectomy.
-Suction assisted Arthroscopic Shaving*

*Definitive Diagnosis and Management of Axillary Hyperhidrosis: The VapoMeter and Suction-Assisted Arthroscopic Shaving.

This last procedure can be done in under an hour under general anesthesia and provides lasting effects by permanently excising the local sweat glands. It is done by marking the hair bearing area of the Axilla, after which 0.5% lidocaine is infiltrated for hemostasis (to reduce bleeding). A small incision is made in the crease area and the Arthroscopic Shaver is introduced and the eccrine glands (Sweat glands) are ablated by "Shaving" them off. This procedure does not damage the hair follicles.

There are support groups for this condition such as the International Hyperhidrosis Society
http://www.sweathelp.org

Wednesday, June 1, 2011

Asian eye lid surgery (blepharoplasty) has become an increasingly popular cosmetic surgery all over the world. A common erroneous belief is that the goal of this type of procedure is to achieve a "westernized" appearance, which is rarely the case. Instead, the goal is most commonly a natural and younger appearance.
There are of course, exceptions to this as is shown in the linked report by CNN below
Often patients will seek this surgery because they feel that a heavy upper lid will limit their expressive ability and thus limit their ability to interact socially. This concept is often misconstrued by American, European and non-Asian individuals as a desire to appear more Caucasian.

Courtesy of www.inimactu.blogspot.com

Click on Image: Courtesy CNN

A deep understanding of the delicate regional anatomy is essential to performing any eyelid surgery. The nuances of the Asian blepharoplasty (Lid surgery) escape many surgeons.

Basic Asian eyelid anatomy

What are some of the characteristics of an Asian eyelid when compared to an occidental eye?
-The presence in varying degrees of an epicanthal fold. When prominent epicanthal folds are present medially (on the nasal side) they can give the undesirable illusion of esotropia (cross-eyed).
-An eyelid crease which is lower set and often not visible. When present, it differs from the non-Asian population in that is parallel to the lid margin and narrows as it reaches the nasal edge of the lid
-The angle of the brow tends to be higher medially (Close to the nose) in Asian eyelids
-Shallow orbits (eye bones)
-Minimally or non Cantilevered supraorbital ridges

The so called "double lid surgery" is the commonly requested surgery make the eyelid crease a more noticeable trait. This procedure has been analyzed over the years and modified many times over the years.

Fast facts about the double eyelid procedure
-The prominence of the epicanthal fold is decreased by doing local flaps
-A lid fold is created by applying parallel sutures that create a new crease which is parallel to the edge of the eye lid
-In expert hands the procedure takes around an hour
-There is a "non-incisional" method for Durable Suture Technique (DST). Long term follow up results on this technique are not yet available.

Potential complications:
One major single surgeon study quoting over 6000 patients in 18 years showed the following complications

Reference#2
During the perioperative period, the pateint may have eyelid swelling which may take weeks to months to return to a normal volume. This must be discussed in advance with the patient.

Courtesy of www.abagongfileswordpress.com

Principles of the Asian "double lid surgery"
This varies greatly between individuals since the presence of an epicanthal fold or how noticeable the eyelid crease is or isn't to begin with differs from person to person. However the principle can be reduced to addressing two key issues:
-A decrease in the prominence of the epicanthal fold
-Creation of a more noticeable eyelid crease

Conclusion:
In the right hands, this procedure yields fast and satisfying results to the patient. However it must be kept in mind that the immediate appearence postoperatively does not reflect the final outcome, which is true of so many other procedures in cosmetic plastic surgery.
Other issues should be recognized, acknowledged and addressed prior to undergoing a blepharoplasty. Amongst these are the presence of asymmetry, eyelid ptosis(droopy eyelid), disfunction or dehiscence of the levator muscle of the eyelid causing droopiness for reasons other than mere excess tissue.
Asian blepharoplasty (eyelid surgery) may be enhanced with a frontal lift.

Monday, May 23, 2011

Aside from the face and neck, hands are the most visible unclothed part of our bodies. Sophisticated techniques have allowed impressive changes in facial beauty, but often, rejuvenation of the hands is overlooked.

A radiant smile and facial features must be harmonious with other physical traits. La Gioconda (The Mona Lisa) is currently owned by the French Government and Sits in the Musee Du Louvre, In Paris. She sustains a mesmerizing and enigmatic stare. But what would she look like if her hands were not soft and Juvenile? It would certainly be inconsistent and detract from her overall beauty.

It is the appreciation for beautiful hands that allows a plastic surgeon with an artistic vision to apply rejuvenating techniques to this all too under appreciated area of the body. The knowledge that the proper techniques for hand rejuvenation are available in the first place will allow it to become a part of a youthful and more befitting appearance. After all, "the eyes cannot see what the mind does not know" expresses this concept elegantly.

Beautiful Hands

A variety of techniques have been used over the years with limited results. Uniformity in the coloration of the skin can be obtained temporarily with topical agents, such as hydroquinone. Unfortunately, this may not apply to all skin tones, does not address the skin laxity that appears with age, nor does it address the fullness characteristic of younger hands. Lasers and chemical peels, improve the overall appearence of the dorsum (back) of the hand by increasing exfoliation, reducing lentigines (skin spots) and improving elasticity. However a youthful hand has a subcutaneous (Under the skin) fullness that obscures veins and tendons. Dermal fillers have been used to replicate this appearence with varying and temporary results.

-Combination of the above techniques such as fat grafting and TCA peels

-Percutaneous Collagen induction (Experimental)

Fat Grafting

To date, fat grafting seems to give a more predictable and long lasting effect. It counters the visible effects of ageing and to some degree may improve skin quality by unknown mechanisms.

Fat grafting allows correction of fat and muscular atrophy (Shrikage) with prominent veins. The technique involves injecting fat into the dorsum of the hand in a progressive manner at the sites where there is more notable depression, such as between the Metacarpals (Bones in the hand). The injection is done through inconspicuous access sites between the fingers in the web spaces.

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About Me

Dr. Magana is devoted to the art and science of plastic surgery. From a young age, he exhibited a profound appreciation for beauty and symmetry. This led him develop a strong affinity toward special effects movie makeup to which he devoted himself for many years working as a hollywood makeup artist prior to entering the world of cosmetic surgery. By making the transition from art to medicine, Dr. Magana soon realized the fields were intertwined. Knowing he could change people’s lives gave him a new direction and motivation in life. He is unusually talented in that he sees things with the eyes of a sculptor and artist applied with the care and precision that his background in plastic surgery has enabled. Dr. Magana has received training and completed fellowships in general surgery, burns, craniofacial surgery, Aesthetic breast surgery and plastic surgery. He has been recognized for his dedication to excellence, winning the “Kenna Given Award” upon completion of his training in plastic surgery.

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This Blog is intended primarily for Patient education.This is NOT an active plastic surgery practice website advertisement. This blog's main purpose is to provide information of a general nature related to plastic surgery.